Provider Demographics
NPI:1285948141
Name:MEZA, THERESA ELENA
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ELENA
Last Name:MEZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13303 RANCHO PENASQUITOS BLVD UNIT A102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-6060
Mailing Address - Country:US
Mailing Address - Phone:760-505-8997
Mailing Address - Fax:
Practice Address - Street 1:625 W CITRACADO PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6428
Practice Address - Country:US
Practice Address - Phone:760-294-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health